IMPLEMENTASI CLINICAL PRACTICE GUIDELINES DAN LUARAN KLINIS ODONTEKTOMI GIGI MOLAR KETIGA RAHANG BAWAH IMPAKSI DI RSGM PROF. SOEDOMO YOGYAKARTA

DIBYO PRAMONO, DRG.,SU.,MDSC., Prof. dr. Hari Kusnanto, DrPH.

2015 | Tesis | S3 Ilmu Kedokteran

Latar Belakang. Perawatan odontektomi gigi molar ketiga impaksi merupakan perawatan yang termasuk kategori high volume, high cost, dan high risk. Undang- Undang Nomor 29 Tahun 2004 tentang Praktik Kedokteran mewajibkan setiap dokter atau dokter gigi yang melaksanakan praktik kedokteran atau kedokteran gigi untuk menyelenggarakan kendali mutu dan kendali biaya. Salah satu upaya untuk meningkatkan kualitas pelayanan kesehatan dan sekaligus mengurangi biaya adalah dengan melakukan implementasi clinical practice guidelines. Tujuan. Untuk mengetahui efektifitas implementasi clinical practice guidelines dalam meningkatkan luaran klinis odontektomi gigi molar ketiga rahang bawah impaksi di Rumah Sakit Gigi dan Mulut Prof. Soedomo Yogyakarta. Metode. Jenis penelitian ini adalah quasi experimental, dengan rancangan pretestposttest without control group. Subjek penelitian ini adalah 171 pasien di Klinik Bedah Mulut RSGM Prof. Soedomo Yogyakarta yang mendapatkan perawatan odontektomi gigi molar ketiga rahang bawah impaksi, yang direkrut secara consecutive. Delapan puluh delapan pasien diambil sebelum implementasi guidelines dan 83 pasien lainnya diambil setelah implementasi guidelines. Pengamatan dilakukan terhadap kejadian komplikasi pada hari ketiga dan hari ketujuh pascaodontektomi. Data hasil penelitian dianalisis dengan menggunakan uji multiple logistic regression dan generalized estimating equations, dengan tingkat kemaknaan sebesar 0,05. Hasil Penelitian. Hasil penelitian ini menunjukkan bahwa pada tahap praimplementasi guidelines, kejadian komplikasi hari ketiga pascaodontektomi gigi molar ketiga rahang bawah impaksi adalah sebesar 80,7%, dan pada hari ketujuh pascaodontektomi, kejadian komplikasinya adalah sebesar 37,5%. Pada tahap pascaimplementasi guidelines, kejadian komplikasi hari ketiga adalah sebesar 67,5%, dan pada pengamatan hari ketujuh, kejadian komplikasinya adalah sebesar 10,8%. Hasil analisis statistik menunjukkan bahwa tidak ada perbedaan kejadian komplikasi hari ketiga (p=0,274), namun ada perbedaan komplikasi hari ketujuh antara sebelum dan sesudah implementasi guidelines (p=0,001). Kesimpulan. Kesimpulan penelitian ini adalah bahwa implementasi clinical practice guidelines tidak menurunkan frekuensi komplikasi hari ketiga, tetapi menurunkan frekuensi komplikasi hari ketujuh pascaodontektomi gigi molar ketiga rahang bawah impaksi. Kata kunci: clinical practice guidelines, komplikasi, odontektomi, gigi molar ketiga rahang bawah impaksi, rancangan pretest-posttest without control group

Background. Odontectomy of impacted lower third molars are considered as high volume, high cost, and high risk treatments. Indonesian Law Number 29/2004 concerning Medical and Dental Practice in Indonesia obligates that every medical doctor and dentist should deliver high quality and low cost treatments to their patients. One measure to improve the quality of dental services, and at the same time reduces cost, is the implementation of dental clinical practice guidelines. Objective. The objective of this study was to determine the effectiveness of the implementation of clinical practice guidelines in improving the clinical outcome of impacted lower third molar odontectomy in Prof. Soedomo Dental Hospital, Faculty of Dentistry, Gadjah Mada University, Yogyakarta, Indonesia. Method. We used a quasi experimental study, with a pretest-posttest without control group design. One hundred and seventy one subjects were recurited by means of a consecutive sampling method from patients receiving odontectomy in the Oral Surgery Department, Prof. Soedomo Dental Hospital, Yogyakarta, Indonesia. Eighty eight of those patients were recruited before the implementation of the guidelines, and the rest were those who underwent treatment after the implementation of the guidelines. At day 3 and day 7 after the odontectomy, patients were clinically examined to measure the occuring post-odontectomy complications. Data were analyzed using a multiple logistic regression and a generalized estimating equations tests, with a 5% significance level. Results. The results of the study showed that in the pre-implementation group, at day 3 examination, the complication rate was 80.7%, and at day 7, the complications were 37.5%. In the post-implementation group, at day 3 examination, the complication rate was 67.5%, and at day 7 examinantion, the complication rate was 10.8%. The results of the statistical analyses showed that there was no difference of day 3 complication incidence (p=0,274), but there was a siginificant difference of day 7 complication rate (p=0,001), between pre-implementation and post-implementation groups. Conclusions. It was concluded that the implementation of clinical practice guidelines did not reduce the frequency of day 3 complications; however, it significantly lowered the rate of day 7 complications. Key words: clinical practice guidelines, complication, odontectomy, impacted lower third molar, pretest-posttest without control group design

Kata Kunci : clinical practice guidelines, komplikasi, odontektomi, gigi molar ketiga rahang bawah impaksi, rancangan pretest-posttest without control group